U.S. Lags Behind Other Countries In Primary Care

In many countries, primary care clinicians serve as the foundation for health care and the “gatekeepers” for more specialized referrals. A new international survey of primary care physicians in eleven countries finds that American doctors are significantly behind many of their counterparts elsewhere in providing access to high-quality care and use of health information technology, according to a study by Cathy Schoen of The Commonwealth Fund and coauthors published November 5 in Health Affairs.

The data, collected from February to July 2009 by Harris Interactive Inc. and subcontractors in each country, were obtained through a combination of mail, online, and telephone surveys. (The method varied by country.) More than 10,000 primary care physicians in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States responded to a common questionnaire. Some of the key findings include the following:

The vast majority (69 percent) of U.S. respondents report that their practices have no provisions for after-hours care, leaving their patients no choice but the emergency room. The U.S. was behind every other country surveyed on this finding.

Fifty-eight percent of U.S. primary care physicians say their patients often have trouble paying for their medications and care, compared to 5-37 percent in the other ten countries.

While 99 percent of doctors in the Netherlands and 97 percent of doctors in New Zealand and Norway used electronic medical records (EMRs), only 46 percent of U.S. doctors reported EMR use.

Nearly half of U.S. physicians (48 percent) said that time spent getting patients’ medications and treatments because of their insurance coverage restrictions was problematic. The U.S. scored higher (that is, worse) than any other country on this question.

While the use of care teams was reported by more than 90 percent of participants in several countries, it was less frequent in the U.S. (59 percent) and even lower in Canada and France.

One-third of U.S. physicians reported receiving any financial incentives for the quality improvement measures tracked in the survey. By contrast, 89 percent of doctors in the U.K. and sizable majorities of their counterparts in the Netherlands, New Zealand, Italy, and Australia report financial incentives of some kind to implement quality initiatives.

The authors conclude: “As the United States looks to develop new primary care models that could work well for patients and physicians, policymakers can learn a great deal from diverse initiatives under way in other countries.”